"Scrap Tire Removal Certifications and Consent Form for Counties and Local Governments" - Ohio

Scrap Tire Removal Certifications and Consent Form for Counties and Local Governments is a legal document that was released by the Ohio Environmental Protection Agency - a government authority operating within Ohio.

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  • Released on April 1, 2017;
  • The latest edition currently provided by the Ohio Environmental Protection Agency;
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Instructions for Scrap Tire Removal and Cleanup
for Counties and Local Governments
Division of Materials and Waste Management
During the 1993 creation of the Ohio Scrap Tire Laws, the Ohio General Assembly included Ohio Revised Code (ORC)
3734.85(E) in the statute that allows for state-funded cleanups without subsequent cost recovery of small tire piles
(fewer than 2,000 tires) provided that six specific conditions are met (below). In 2012, the Ohio General Assembly
increased the maximum number of eligible tires under this statute from 2,000 to 5,000 tires per site.
Scrap Tire Consent and Program Eligibility
This instruction sheet applies to Ohio counties, municipal corporations, townships, villages and solid waste management
districts or other governmental authorities for removal of illegally dumped scrap tires on public property or right of ways.
The Scrap Tire Consent Form is to be used for scrap tire sites having no less than 100 tires and no more than 5,000 tires.
The scrap tires may be any size and may be un-mounted or on rims. Tires collected during tire amnesty collection events
are not eligible for pick-up and disposal under this program.
Submission Instructions/Checklist
Please provide 1) Consent Form, 2) Deed, and 3) Photos and Map to Ohio EPA. Incomplete application packages will
not be considered.
1)
Consent Form
a. Provide parcel information in Section 1, line 1 and a complete address of tire location.
b. Provide signature of authorized agent or property owner listed on deed.
2)
Recorded Deed (attachment)
Attach a copy of the recorded parcel deed which provides a complete legal description of the parcel in
Section 1, line 1. (Documents are available at the county auditor's office.)
3)
Photos/Map (attachment)
Attach site photo(s) and a map showing an X where the scrap tires are located and include property
boundaries.
Send the completed consent form with attachments to:
Ohio EPA DMWM/Scrap Tire Unit
Lazarus Government Center
P.O. Box 1049
Columbus, Ohio 43216-1049
For questions or assistance, contact the Division of Materials and Waste Management at (877) 372-2621.
1
Revised 4/2017
Instructions for Scrap Tire Removal and Cleanup
for Counties and Local Governments
Division of Materials and Waste Management
During the 1993 creation of the Ohio Scrap Tire Laws, the Ohio General Assembly included Ohio Revised Code (ORC)
3734.85(E) in the statute that allows for state-funded cleanups without subsequent cost recovery of small tire piles
(fewer than 2,000 tires) provided that six specific conditions are met (below). In 2012, the Ohio General Assembly
increased the maximum number of eligible tires under this statute from 2,000 to 5,000 tires per site.
Scrap Tire Consent and Program Eligibility
This instruction sheet applies to Ohio counties, municipal corporations, townships, villages and solid waste management
districts or other governmental authorities for removal of illegally dumped scrap tires on public property or right of ways.
The Scrap Tire Consent Form is to be used for scrap tire sites having no less than 100 tires and no more than 5,000 tires.
The scrap tires may be any size and may be un-mounted or on rims. Tires collected during tire amnesty collection events
are not eligible for pick-up and disposal under this program.
Submission Instructions/Checklist
Please provide 1) Consent Form, 2) Deed, and 3) Photos and Map to Ohio EPA. Incomplete application packages will
not be considered.
1)
Consent Form
a. Provide parcel information in Section 1, line 1 and a complete address of tire location.
b. Provide signature of authorized agent or property owner listed on deed.
2)
Recorded Deed (attachment)
Attach a copy of the recorded parcel deed which provides a complete legal description of the parcel in
Section 1, line 1. (Documents are available at the county auditor's office.)
3)
Photos/Map (attachment)
Attach site photo(s) and a map showing an X where the scrap tires are located and include property
boundaries.
Send the completed consent form with attachments to:
Ohio EPA DMWM/Scrap Tire Unit
Lazarus Government Center
P.O. Box 1049
Columbus, Ohio 43216-1049
For questions or assistance, contact the Division of Materials and Waste Management at (877) 372-2621.
1
Revised 4/2017
Scrap Tire Removal Certifications and Consent Form
for Counties and Local Governments
Division of Materials and Waste Management
This Scrap Tire Removal Certification and Consent form applies to Ohio counties, municipal corporations, townships,
villages and solid waste management districts or other governmental authorities applying for removal of illegally dumped
scrap tires on public property or right of ways pursuant to Ohio Revised Code (ORC) 3734.85(E).
Section 1: Scrap Tire Temporary Storage Location
This section of this form applies to the current, temporary storage location of the scrap tires. The temporary storage
location is the location where the state contractors will enter to remove scrap tires. Please attach a copy of the
property deed to this form.
1)
The undersigned represents the owner of a parcel of real estate located in
Ohio,
County
whose legal description is recorded in
of the
deeds as attached.
Volume, Page
County Recorded
a) Address:
City:
Zip Code:
-
If applicable, other directions to better describe location of scrap tire location (for example: the site is 500
yards north of 14 Spring Street or at the SE corner of Elm and Oak):
b) Insert the approximate number of scrap tires to be removed:
NOTE: The items below apply to the signatory of this form. By signing, the signatory verifies that they understand and
agree to the following.
2)
The undersigned hereby authorizes and consents to the entry upon the above-described real estate by officers,
employees, authorized representatives, or contractors of the State of Ohio, upon showing proper identification,
for such actions as are necessary to remove scrap tires and other associated solid wastes, if any, from the above-
described real estate.
3)
The undersigned hereby certifies that there are 5,000 or less scrap tires located on the above-described real
estate. ORC 3734.85(E)
4)
The undersigned hereby agrees to waive any claims which may arise against the State of Ohio or their officers,
employees, authorized representatives, or contractors in the course of performing the actions described above.
The undersigned hereby also agrees to hold harmless the State of Ohio, or any officers, employees, authorized
representatives, or contractors utilized by the Ohio Environmental Protection Agency to affect the removal, for
any damage to property incurred during the course of action under this Scrap Tire Removal Certifications and
Consent Form, except to gross negligence or intentional misconduct.
5)
The undersigned agrees to provide any assistance requested by the Ohio Environmental Protection Agency or
their officers, employees, authorized representatives, or contractors of the Ohio Environmental Protection
Agency in locating scrap tires on the above-described real estate or making arrangements to facilitate their
removal.
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Revised 4/2017
6)
This consent is granted so that the State of Ohio can undertake the removal of up to 5,000 scrap tires and other
solid wastes at the above-described real estate at no cost to the undersigned and without a lien attached to the
property pursuant to ORC 3734.85.
7)
The undersigned certifies that the information provided in this request is truthful and in compliance with Ohio
Revised Code § 2921.13.
Section 2: Scrap Tire Collection Area(s)
This section of this form applies to property area(s) where scrap tires (located at above-described real estate), were
picked up by road crews and/or volunteers, etc., from public property, roadways, rights-of-way or during river clean-up
sweeps.
1)
The undersigned hereby certifies as a representative of the owner of the property that the scrap tires
temporarily stored at the above described real estate, were picked up from public property, roadways, rights-of-
way, or during river sweeps.
2)
The undersigned hereby certifies as a representative of the owner of the property that the tires were placed on
the property after the owner acquired title to the property.
3)
The undersigned hereby certifies that as a representative of the owner of the property, the owner did not have
knowledge that the tires were being placed on the property, or the owner posted on the property signs
prohibiting dumping, or took other action to prevent the placing of tires on the property. ORC 3734.85(E)(2)
4)
The undersigned hereby certifies that as a representative of the owner of the property, the owner did not
participate in or consent to the placement of tires on the property. ORC 3734.85(E)(3)
5)
The undersigned hereby certifies that as a representative of the owner of the property, the owner received no
financial benefit from placing of the tires on the property or otherwise having the tires on the property.
ORC 3734.85(E)(4)
6)
The undersigned hereby certifies that as a representative of the owner of the property, the title to the property
was not transferred to the owner for the purpose of evading liability under ORC 3734.85(A). ORC 3734.85(E)(5)
7)
The undersigned hereby certifies that as a representative of the owner of the property, the person responsible
for the placing the tires on the property, in doing so, was not acting as an agent for the owner of the property.
ORC 3734.85(E)(6)
8)
The undersigned, as a representative of the owner of the property, hereby relinquishes any claim of an
ownership interest in any scrap tires or solid waste that are removed or in any proceeds from their sale.
9)
The undersigned, as a representative of the owner of the property, agrees that this consent shall remain in effect
for a period of 2 (two) years. During this two-year period, all scrap tire removal requests will include the 1) date
and address of tire site, 2) tire count for each area and Secondary Identification Number assigned by Ohio EPA for
subsequent scrap tire removal.
Printed Name(s):
Mailing Address:
City:
State:
Zip Code:
-
Phone:
(
)
-
Email:
Project Point of Contact:
Phone: (
)
-
Date:
/
/
Signature of Authorized Agent of Property Owner:
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